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NPI Code Detail

MEDICARE: PEDIATRIC PLASTIC SURGERY, PLLC

MEDICARE: PEDIATRIC PLASTIC SURGERY, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0122XPlastic and Reconstructive Surgery PhysicianTX

General Provider Information

NPI Number : 1558419358
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC PLASTIC SURGERY, PLLC
Provider Business Mailing Address
First Line : 7777 FOREST LN STE C528
Second Line :
City : DALLAS
State : TX
Zip : 75230-6848
Country : US
Telephone Number : 972-331-7711
Fax Number : 972-331-1911
Provider Business Practice Location Address
First Line : 7777 FOREST LN STE C528
Second Line :
City : DALLAS
State : TX
Zip : 75230-6848
Country : US
Telephone Number : 972-331-7711
Fax Number : 972-331-1911
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MRS. JULI A SMIDDY
Credential :
Telephone Number : 972-331-7711
Provider Enumeration Date : 01/08/2007
Last Update Date : 04/16/2021

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Directions to “PEDIATRIC PLASTIC SURGERY, PLLC ” Practice Location

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